Macloud Nyeruke

Kevin McLoughlin 
Senior Coroner 
West Yorkshire (Eastern)  
Coroner’s Office and Court 
71 Northgate 
Wakefield 
WF1 3BS  

Dear Mr McLoughlin 

EMPLOYMENT AGENCIES ACT 1973  

Regulation 28 report to Prevent Future Deaths (following death of Mr Macloud 
Nyeruke) 

Thank you for sending us a copy of the Regulation 28 report following the sad death 
of Mr Macloud Nyeruke, and the subsequent correspondence that you had with 
, Director of Group Risk (Reed Specialist Recruitment Limited trading as 

Reed Nursing Agency) and Dr 
, Chief Medical Officer (Leeds Teaching 
Hospital NHS Trust).   This sad incident had also been brought to our attention by 
Reed Specialist Recruitment Limited. 

I should explain that the Employment Agency Standards (EAS) Inspectorate in the 
Department for Business, Energy and Industrial Strategy (BEIS), is responsible for 
enforcing the provisions of the Employment Agencies Act 1973 and associated 
Conduct of Employment Agencies and Employment Businesses Regulations 2003. 
This legislation requires employment agencies (that find work for persons with 
employers) and employment businesses (that employ workers and hire them out to 
act for and under the control of hirer) to abide by specified minimum standards of 
conduct.  

The obligations of the legislation require specific checks and authorisations to be 
carried out by agencies or employment business where they introduce or supply 
work-seekers to hirers.  These processes are aimed to ensure that work-seekers, 
including healthcare workers and professionals, that are introduced or supplied to 
hirers (such as NHS Trust) are suitable to work in the position that the hirer seeks to 
fill. 

The legislation would apply to agencies and employment businesses whether they 
act as a direct supplier of work-seekers to a hirer, or through a recruitment supply 
chain. 

Employment Agency Standards Inspectorate, Economics and Markets Group, BEIS, Spur 1, 1Victoria Street, 
London, SW1H 0ET 

Direct Line 

Enquiries +44 (0)20 7215 5000   

 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 We will investigative this matter further in accordance with the legislative framework 
of the Employment Agencies Act 1973 and associated Conduct Regulations. 

This will include the requirement for agencies and employment businesses to comply 
with the following regulations: -     

•  Regulation 18 – information to be obtained from hirers, including the position 
which the hirer seeks to fill, the type of work a work-seeker in that position 
would be required to do, any risks to health or safety known to the hirer and 
what steps the hirer has taken to prevent or control such risks;  in addition the 
experience, training, qualifications and any authorisation which the hirer 
considers are necessary, or which are required by law, or by any professional 
body, for a work-seeker to possess in order to work in the position. 

•  Regulation 19 – confirmation to be obtained about a work-seeker including 
that the work-seeker has the experience, training, qualifications and any 
authorisation which the hirer considers are necessary, or which are required 
by law or by any professional body, to work in the position which the hirer 
seeks to fill. 

•  Regulation 20 – steps to be taken for the protection of the work-seeker and 
the hirer including (without prejudice to any of its duties under any enactment 
or rule of law in relation to health and safety at work) making all such 
enquiries, as are reasonably practicable, to ensure that it would not be 
detrimental to the interests of the work-seeker or the hirer for the work-seeker 
to work for the hirer in the position which the hirer seeks to fill. 

•  Regulation 22 – additional requirements where professional qualifications are 
required or where work-seekers are required to work with vulnerable persons 
including, oobtaining copies of any relevant qualifications or authorisations of 
the work-seeker; obtained two references from persons who are not relatives 
of the work-seeker; taken all other reasonably practicable steps to confirm 
that the work-seeker is suitable for the position concerned.  

If you require any further information, or have any further information to pass to us, please 
do not hesitate to contact me. 

Thank you for bringing these matters to my attention. 

Yours sincerely  

Head of Enforcement and Sanctions 
Employment Agency Standards Inspectorate

Date: 19th November 2020 

Your Ref: 
Our Ref: 

Mr Kevin McLoughlin 
Senior Coroner 
West Yorkshire (Eastern) 
Coroner’s Office and Court 
71 Northgate 
Wakefield 
WF1 3BS 

Dear Mr McLoughlin 

Chief Medical Officer 
Trust Headquarters 
St James’s University Hospital 
Beckett Street 
Leeds 
LS9 7TF 

Direct Line: 
Email: 

PA: 

www.leedsth.nhs.uk 

INQUEST TOUCHING THE DEATH OF MACLOUD NYERUKE (Deceased) 

I refer to your correspondence of 18th September 2020, regarding the inquest touching the death of Mr 
Macloud Nyeruke and the Regulation 28 Report to Prevent Future Deaths in respect of this case. 

I can confirm that the contents of your Regulation 28 Report have been shared with the relevant staff to 
enable us to provide you with a comprehensive response.   

In your report you highlight that your matters of concern were as follows: 

(1)  Mr Nyeruke’s medical conditions were not made known to the Trust. In consequence, he had 
worked on wards where patients had infections involving multi-resistant organisms. Given his 
compromised immune state, this situation involved risk to both patients and Mr Nyeruke himself. In 
the absence of information concerning a particular staff member’s medical condition there is a risk of 
transmission of infections either to or from the staff member. 

(2)  There is scant evidence as to whether Mr Nyeruke underwent appropriate training in respect of PPE 

such as masks before being permitted to work on a ward involving infectious diseases. The 
difficulties involved (where a support worker supplied by a nursing agency is only in the hospital for a 
brief period) are acknowledged.  Nonetheless, the risk of an adverse transmission of infection either 
to, or from, the staff member necessitates stringent standards being enforced, with appropriate 
records preserved. 

(3)  Nursing agencies which supply support workers to hospitals without knowledge of their particular 
health vulnerabilities, or where they will be working, give rise to a risk that they may be adversely 
affected or may give rise to adverse effects on patients or colleagues. 

We have considered the contents of your report very carefully and our response is set out below. We have 
not responded to point 3 as we believe this matter rests with the Reed agency. 

In response to point one, our investigations have established that all the suppliers of our bank and agency 
staff members are responsible for ensuring the occupational health screening of their workers is completed 

The Leeds Teaching Hospitals NHS Trust incorporating: Chapel Allerton Hospital, Leeds Cancer Centre, Leeds Children’s Hospital, 
Leeds Dental Institute, Leeds General Infirmary, Seacroft Hospital, St James’s University Hospital, Wharfedale Hospital. 

   
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 in line with an agreed national framework.  The results of this screening are not disclosed to the organisation 
where the bank or agency member of staff is placed.  The Trust is therefore reliant on the agency and the 
worker assessing the risk to the individual and other staff and patients prior to placement.  It should be noted 
however there is no enforceable obligation on a member of staff be they bank, agency or a Trust employee 
to disclose information about their health. The exception to this would be where the condition poses a direct 
threat to the health of others, but even in these cases we are very much reliant on the member of staff’s 
openness despite the fact that the failure to disclose is a potential breach of Health and Safety legislation.  

As a consequence, the Trust has a number of infection control measures in place aimed at mitigating the risk 
of cross infection. For example, there are standard precautions in place, (also known as universal 
precautions) which are intended to reduce the risk of transmission of blood borne and other pathogens from 
both recognised and unrecognised sources. They are the infection control precautions which are to be used, 
as a minimum, in the care of all patients.  Hand hygiene is a major component of these standard precautions 
as is the wearing of personal protective equipment, the use of which is guided by risk assessment and the 
extent of contact anticipated with blood and bodily fluids, or pathogens.  In addition to practices carried out 
by our healthcare staff when providing care, all individuals, (including patients and visitors), are required to 
comply with infection control practices in wards/departments. 

As well as the standard infection control precautions outlined above, the Trust has a range of supporting 
guidelines in place to underpin the provision of safe care and treatment of patients with specific infectious 
diseases, including TB and Covid-19. 

The Trust’s Guideline for the Management of Tuberculosis (Including Multi drug and Extensively Drug 
Resistant Tuberculosis) explains that there is no clear evidence on the value / efficacy of face masks in 
preventing the acquisition of tuberculosis infection; and there is conflicting guidance as to their appropriate 
use in the health care setting. However, there is some evidence that there is a decreased risk of 
transmission when masks are worn. The wearing of masks by patients with respiratory TB disease is to 
directly protect others; the wearing of masks by staff and visitors is to protect themselves - which is why the 
category of mask recommended differs. 

The guideline recommendations that fitted FFP 3 masks are recommended for staff: 

•  Providing care for any suspected or confirmed respiratory TB in hospital in-patient over the age of 

ten when sputum smear status awaited or is positive in single room, until the patient has completed 
a minimum of two weeks of anti-TB treatment.   

• 

In situations where respiratory TB is a possibility / confirmed, & exposure to large numbers of M. 
tuberculosis bacilli is possible, e.g. bronchoscopy, cough inducing procedures including chest 
physiotherapy and sputum induction; until the patient has completed a minimum of two weeks of 
anti-TB treatment and drug-resistant TB is not suspected. 

•  When entering the negative pressure room of a Multi-Drug Resistant TB patient  

The guideline includes instructions on the correct wearing of a FFP 3 mask but states that the correct fit of 
the FFP 3 mask needs to be confirmed prior to use. This is achieved by a process called “fit testing”. All staff 
that care for TB patients should ensure that they have been successfully fit tested on the FFP3 masks 
currently available in the Trust. 

The FFP3 mask must be fit tested by a competent person (HSE 2012). All areas are required to have an 
identified fit test trainer available to fit test staff if a suspected or confirmed TB patient is admitted. You will 
recall that when Mr Nyeruke attended the ward, prior to commencing work he was asked if he had been fit 
tested and he confirmed that he had been.  It was only subsequent to becoming infected with TB that he 
then said he could not recall if he had been. 

The TB guideline makes it clear that staff who have suppressed immunity MUST avoid contact with known or 
suspected cases of TB. This includes students of medicine, nursing and locum staff etc.  If unsure of their 
status, staff should refer to the Trust’s Occupational Health Service (or other occupational health provider 
where relevant.). As you heard in evidence, the Trust had no knowledge of Mr Nyeruke’s 
immunosuppressed status. 

Ultimately the Trust relies on the agency and their staff member risk assessing whether it is appropriate for 
them to be placed in a specific clinical area.  

The Leeds Teaching Hospitals NHS Trust incorporating: Chapel Allerton Hospital, Leeds Cancer Centre, Leeds Children’s Hospital, 
Leeds Dental Institute, Leeds General Infirmary, Seacroft Hospital, St James’s University Hospital, Wharfedale Hospital. 

   
  
 
 
 
 
 
 
 
 
 
 
 
 
 In response to point 2 the Trust acknowledges that there was no documentary evidence to support Mr 
Nyeruke’s confirmation that he had been fit tested prior to working on J20.  Following receipt of your PFD 
report the Trust has been in discussions with Reed with a view to obtaining more robust assurance that an 
agency staff member has undergone Fit testing prior to working in an area where FFP 3 masks are required.  

For the booking of bank and agency staff there is a computer system called Health Roster which relevant 
staff within the Trust can access.  Reed have been adding “fit tested” as a skill to the system as and when 
their staff have been tested. Previously this information was not available to Trust staff to view.  Reed have 
confirmed that they can make this skill visible so that anyone with Health Roster access on the shift can 
verify if the bank or agency candidate has been fit tested. 

All bank and agency workers will be asked to inform Reed once they have been fit tested so that the skill can 
be added to their profile.  This action has already commenced, and additional fit testing is being provided 
outside of the usual Clinical Service Unit provision. 

In addition to the above, some wards are adding ‘bank notes’ to shifts that need covering specifying that the 
bank or agency staff member must be fit tested prior to attending the shift.  Bank notes are accessible by 
bank and agency workers when booking the shift.  We plan to standardise this approach Trust-wide so that 
high risk areas routinely add this to any shifts going out to bank and agency staff. To reassure ourselves that 
this is working we plan to audit the number of staff with the fit tested skill attached to Health Roster in the 
high-risk areas, including Infectious Diseases. 

During our discussions we explored whether there was any way we could prevent high risk/vulnerable 
workers from viewing available shifts where a ‘general skill’ such as being fit tested or having IV drug 
competency is attached. We concluded that the system would not allow us to do this; however, all bank and 
agency staff assessed as being high risk or vulnerable have been advised to call Reed to check the status of 
a ward during Covid.  All bank and agency staff classed as vulnerable or high risk have been advised to 
carry with them a copy of their risk assessment in case of any potential ward moves once their shift 
commences. 

The contract with Reed ends on 31st March 2021 and the staff bank will come back under the Trust. When 
this happens, we will have the opportunity to introduce more robust methods of recording training and 
competencies within our Electronic Staff Record system as bank only staff will be Trust employees. 

Thank you for bringing these matters to my attention. I do hope that this response has assured you that the 
Trust has given careful consideration to the matters of concern you have raised. 

If I can be of any further assistance, please do not hesitate to contact me. 

Yours sincerely 

Dr 
Chief Medical Officer 
Leeds Teaching Hospitals NHS Trust 

The Leeds Teaching Hospitals NHS Trust incorporating: Chapel Allerton Hospital, Leeds Cancer Centre, Leeds Children’s Hospital, 
Leeds Dental Institute, Leeds General Infirmary, Seacroft Hospital, St James’s University Hospital, Wharfedale Hospital.

Reed Specialist Recruitment Ltd 

By email from 

04 December 2020 

Mr K McLoughlin 
Senior Coroner 
By email to 

RE: Response to Mr McLoughlin’s letter dated 19th November 2020 

Dear Mr McLoughlin, 

Thank you for your letter dated 19 November 2020, the content we have noted. 

As I stated in our initial reply, we take this matter very seriously and we will continue to work 
with the appropriate authorities to ensure a thorough review is undertaken. 

In your letter, you state that “In consequence, I wished to draw Reed’s attention to the 
potential danger in order that the agency can review its arrangements and procedures to 
avoid a repeat of comparable circumstances.” Please note that Reed has acted as a 
Managed Agent Supplier (under the CCS Framework Agreement) to Leeds Teaching 
Hospital NHS Trust (LTHT).  Under this arrangement, Reed acts as a managing agent to the 
staff bank which includes managing the shift allocation and booking of staff through a 
nominated supply chain. This does include some supply by Reed direct, but mostly the 
booking of permanent LTHT staff, bank staff, and other agency staff.   

At the point when Mr Nyeruke was first introduced to LTHT this was via ID Medical in 
November 2016, as prior to Reed's involvement with LTHT ID Medical had a contract direct 
with the Trust and not a sub-contractual arrangement via Reed.  Reed then entered into a 
sub-contracting arrangement with ID Medical in January 2019 as part of Reed then 
managing the staff bank, for the supply of Mr Nyeruke.  After having thoroughly investigated 
the matter, I can confirm that Reed has fully complied with its contractual obligations towards 
LTHT and received confirmation from ID Medical to confirm that Mr Nyeruke was suitably 
vetted and medically fit to commence the temporary assignment at LTHT. Moreover, Reed 
did also perform the necessary audits on ID Medical to confirm that the required health 
checks and training (in relation to PPE) for Mr Nyeruke were performed.  

Both contractually and legislatively the responsibility on ID Medical was to carry out an 
occupational health assessment and training. I can confirm Reed have seen evidence of this 
dating back to 2012 which falls in line with when Mr Nyeruke first engaged with ID 
Medical.  However, Reed are unable to investigate the detailed evidence beyond the health 
clearance such as the medical declarations made by Mr Nyeruke, and other supporting 
evidence that underpin the occupational health fitness to work certificate, nor can we fully 
scrutinise the training content that sits behind the certificates. This is a matter for the 
regulator and Crown Commercial Service, which is why we escalated this matter to them 
within 24/76 hours of receiving your initial report. 

In response to the reason LTHT were not informed of any underlying issues in relation to Mr 
Nyeruke’s health was because Reed were not informed by the employer/supplier, ID 
Medical. This is further backed up from the documentation that we have audited which does 
not declare any issue regarding Mr Nyeruke.  I cannot comment on why LTHT were not 
informed of any issues during the supply of Mr Nyeruke to them prior to Reed managing the 
supply chain as I am not privy to that information. 

 
 
 
 
 
 
  
  
  
 
 
  
 I can confirm that for workers supplied by Reed direct, full occupational health and training is 
carried out and relevant information shared with the client.  

I fully appreciate the seriousness of this matter and therefore we had already taken the 
necessary steps to notify the Employment Agency Standards (EAS) as well as the NHS 
Framework Crown Commercial Service (CCS). Following your recent response, I have also 
personally explained the position to the Care Quality Commission (CQC) too. As Chair of the 
first cross-government and 3rd party organisation focusing on labour market and supply 
chain compliance and worker rights I am committed to ensuring the safety of non-permanent 
workers and identifying any weaknesses in modern supply chains. As such, I continue to talk 
to the EAS and CCS about this matter and how a joint, multi-agency approach could improve 
standards. To do this, it is important to understand the detail surrounding the occupational 
health assessments and training to understand what may have gone wrong. On this point we 
will work with the regulator in future based on any findings that come of the investigation.    

My suggestion to re-address the Regulation 28 Report to ID Medical was made on the basis 
that Reed is unable to take any steps other that I have set out above in relation to individuals 
supplied by sub-contractors and that ID Medical as the employer/supplier, should be made 
aware of this Report in order to take additional measures (you deem fit) to protect the health 
and safety of temporary workers they engage. 

I will share a copy of this letter with the EAS, CCS, CQC, and Leeds Teaching Hospital. I 
would also be very happy to engage any other bodies or organisations you see fit to work 
towards addressing any issues within modern supply chains. 

Yours sincerely, 

Director of Group Risk & Reed Screening 
Reed Specialist Recruitment Ltd.